Wesley Harlan Kingsbury, the general manager of a California ambulance company, pled guilty to conspiracy to commit Medicare fraud, conspiracy to obstruct a Medicare audit, and making materially false statements to law enforcement officers after he was charged for his involvement in a scheme to defraud Medicare. According to a Department of Justice (DOJ) press release, Kingsbury will be sentenced in February 2015, for his criminal involvement in the scheme that included the owners and the training supervisor of Alpha Ambulance Inc. (Alpha), all of whom have already been sentenced for their roles in the conspiracy.

Scheme

According to court documents, Kingsbury conspired with his coworkers to bill Medicare for ambulance services that Kingsbury knew to be unnecessary. The charges also alleged that Kingsbury used his position as a general manager to instruct emergency medical technicians (EMTs) who worked for Alpha to alter paperwork to conceal the true medical conditions of the individuals they fraudulently transported. After learning that Alpha was going to be subject to an audit, Kingsbury allegedly used light tracing tables to create and alter documents to send to Medicare, as well as shredded original documentation to conceal the fraud. In total, the scheme resulted in $5,522,079 in fraudulent claims to Medicare, $1,338,413 of which Medicare paid.

Lies

Kingsbury was approached by law enforcement and asked to help them in their investigation of Alpha. According to the DOJ release, Kingsbury told Alpha’s owners about law enforcement approaching him and told the company’s owners the names of the law enforcement officers, as well as the questions he was asked. When asked later, Kingsbury allegedly falsely denied to law enforcement that he had disclosed the information to Alpha’s owners.

Investigation

The case that was investigated by the Federal Bureau of Investigation (FBI) and the HHS Office of Inspector General (OIG) has already led to sentences of 75, 108, and 30 months for the two owners and the training supervisor of the ambulance company. The case is being celebrated as a success for the Health Care Fraud Prevention and Enforcement Team (HEAT), which, to date, has charged almost 2000 defendants for billing Medicare a collective $6 billion.